Annual report 2019/20 Our annual report for 2019/20 is dedicated to the commitment and expertise of all of our people who are playing a vital role in the UK’s on-going response to COVID-19. We pay special recognition to our colleagues who have died during the pandemic to date and celebrate their lives and contribution to the NHS: Melujean Ballesteros Professor Mohammed Sami Shousha Donald Suelto Jermaine Wright Contents Welcome 3 Performance report 5 Overview 6 About the Trust 9 Trust in numbers 12 Performance analysis 14 Sustainability report 34 Quality account 37 Annex 1 61 Annex 2 66 Accountability report 67 Corporate governance report 68 Annual governance statement 75 Care Quality Commission Regulatory Framework 80 Chief executive’s review of effectiveness 86 Remuneration and staff report 88 Remuneration report 88 Staff report 93 Trade Union facility time publication requirements report 95 Financial statements 106 Appendices 141 Glossary of terms 142 Alternative formats This document is also available in other languages, large print and audio formation on request. Please contact the communications directorate [email protected] 2 Welcome Welcome to the annual report for Imperial College Healthcare NHS Trust for 2019/20. As the year drew to a close, we faced probably our biggest ever challenge as an organisation. Along with the rest of the NHS, our five hospitals in central and west London became part of the frontline in the UK’s response to COVID-19. I could not be prouder of what our 13,000 staff have achieved. Within just a few weeks, we transformed our usual services and expanded intensive care to meet the growing, urgent need created by the global pandemic. Our people worked incredibly hard in very difficult circumstances, taking on new roles and working in unfamiliar areas while managing risks to their own health and worrying about family and friends. I am hugely grateful to them. I also want to express my Paula Vennells CBE heartfelt respect for our four colleagues who died Chair during the pandemic and for the many more who have suffered ill health or the loss of loved ones. It is clear there will be many more challenging times to come – not just the likelihood of further waves of infection but also the longer term transformation we’ll need to make in the way we live and work as we await a reliable vaccine. Looking more broadly, we will continue to respond with kindness and expertise to the growing and changing care needs of our patients and wider population, which will only become more complex with the on-going demands of COVID-19. Reassuringly, we have built strong strategic foundations, which will stand us in good stead for the difficult months and years ahead. This progress was recognised by the Care Quality Commission when they inspected us last year and increased our rating for well-led overall to ‘good’, as well as awarding ‘good’ or ‘outstanding’ ratings for all eight of the services that were under scrutiny. My congratulations to all maternity service colleagues – at Queen Charlotte’s & Chelsea and St Mary’s – for achieving ‘outstanding’! NHS Improvement also acknowledged our improvement, moving us from level three oversight, under their single overview framework, to level two, reflecting no significant concerns. We continued to build our strategy during 2019/20, working with colleagues and partners. Our focus on delivering ‘better health, for life’ – through integrated care for our local population, developing a sustainable portfolio of outstanding services (with international impact as well as local benefit), and ensuring learning, innovation and improvement in everything we do – will be even more important in a COVID-19 world. Our chief executive, Professor Tim Orchard, his executive and teams right across the Trust have put huge energy into bringing our organisational values to the fore, ensuring that each of us knows them – kind, expert, aspirational, collaborative – and lives them. We’ve all been rewarded by the kindness we Annual Report 2019/20 | 3 Within just a few weeks, we transformed our usual services and expanded intensive care to meet the growing, urgent need created by the global pandemic. have witnessed over the past few weeks, especially at We also continue to tackle a significant underlying some of our bleakest moments. Our patients and staff financial deficit. Some of our challenge is related to have benefitted enormously from collaborations made our poor estate but there are other factors too and possible by our deepening partnerships – with Imperial we have some way to go to ensure our finances are Health Charity, Imperial College London, our local sustainable over the longer term. The team worked authorities, GPs and other NHS organisations. Our lay hard to achieve our financial plan in 2019/20 but we partners are increasingly core to the way we work still had to rely on some non-recurrent measures to – with their central role in all of our key projects, meet the more ambitious control total we were set – it was an obvious step to include them in shaping this has meant a slight worsening of our underlying our COVID-19 response from the start. position. It’s unclear what the COVID-19 pandemic will mean for our financial plan for 2020/21 and for We have continued to widen and strengthen our expectations around sector-level change. Whatever expertise in innovation, improvement and research. happens, maintaining our strong financial grip Along with Imperial College London, The Royal of the past four years will be essential. Marsden, Royal Brompton and Harefield and the Institute of Cancer Research, we bid successfully to be There is one further, emerging issue that I would like to ‘re-designated’ as an academic health science centre share. In our 2019 strategic refresh, we made a new (AHSC). Our aspiration to drive even better outcomes commitment to reduce health inequalities within our for patients has seen us, together with Imperial services and communities. The importance of this College London, at the centre of some of the most ambition is underlined as we learn that COVID-19 is promising developments in relation to COVID-19, disproportionately impacting black, Asian and minority devising reliable approaches to testing for patients ethnic communities and people who live in poorer and staff, vaccine trials and research to understand areas. It must remain at the forefront of our agenda. the disease and discover better treatments. I’ve also While I have been transparent about the scale of our been delighted to see the ever growing impact of challenges, I remain excited and optimistic for our digital transformation. We adopted virtual outpatient future – and for what I believe we can achieve appointments and consultations during the COVID-19 together with our patients and partners. Imperial crisis and have learnt how many patients and clinicians College Healthcare NHS Trust is blessed with have preferred them; while not a replacement for outstanding colleagues and inspiring and capable face-to-face, they have a significant role to play. They leadership. The COVID-19 pandemic has reminded and other digital capabilities developed by our everyone just how precious the NHS is and I am in awe outstanding ICT teams are an essential element of of how hard my colleagues work to care for patients preparedness for whatever the future holds. and to save lives. In recognition of that, our task Progress on other key strategic issues will require more – together with our patients, local communities and of our attention in the year ahead. Even before other stakeholders – is to make the most of the COVID-19, our old and worn out buildings were being opportunity we have to learn lessons and to celebrate stretched to their limit – all of our sites are in desperate kindness and expertise, to ensure the best possible need of redevelopment or renovation. We continue to NHS for the future. have the largest backlog maintenance liability of all NHS trusts and estate failures created more operational problems this year than ever. Our inclusion in the government’s healthcare infrastructure plan was a major breakthrough, and we are currently exploring a partnership with a major developer to build a brand new St Mary’s Hospital as a first stage of a multi-site Paula Vennells CBE improvement programme, but we have much to do Chair and increasingly little time in which to do it. 4 Performance report Annual Report 2019/20 | 5 many volunteering to work on the frontline Overview themselves. If we do look back at the first eleven months of 2019/20, themes emerge that are still relevant now, in what feels like a quite different world. They offer hope and support as we respond to the continuing challenges of both coronavirus and the longer- standing issues arising from growing and changing health and care needs. Creating a positive organisational culture While NHS trusts like ours have to grapple with a wide range of priorities, it’s clear that, above all else, we need to create the best possible organisational culture. One directed by a clear and shared vision of what we want to achieve, shaped by a set of meaningful values, and in which staff feel listened to, empowered and valued. We expanded our work in Professor Tim Orchard this area during 2019/20, running interactive values Chief executive awareness workshops for everyone, introducing active bystander training to support staff in challenging poor behaviours and developing an organisational Just a couple of weeks past the peak of coronavirus management system. infections in London, it’s not an easy time to reflect on We also targeted improvements in areas where staff the whole of 2019/20.